Managing a Parent’s Care When You Live Out of State: 11 Steps That Actually Help

You can manage a parent’s care well from another state. It takes the accurate paperwork, a few individuals on the ground and a clear plan before something goes wrong.

Hard lessons teach most long-distance caregivers about this. The call comes from a hospital social worker or a neighbor, and suddenly you’re booking a last-minute flight with no idea who your mother’s doctor is or where she keeps her insurance card. We hear versions of that story from families every week.

This list is what we’d tell a friend in your position. Some steps take an afternoon. A few take real conversations you may have been putting off. All of them make the next emergency easier, and some will prevent it.

1. Use Your Next Visit to See What’s Really Going On

Phone calls hide a lot. Parents who are struggling get good at sounding fine for fifteen minutes, so your next visit is your best source of information. Stay a few days if you can, and pay attention to the house as much as the conversation.

Things worth checking quietly:

• The fridge. Expired food, very little food or a dozen of the same item can all point to trouble with shopping, cooking or memory.
• The mail. Unopened bills, late notices or a pile of donation requests and sweepstakes letters can be early signs of confusion or a scam.
• Pill bottles. Compare the refill dates to the dosage. Too many pills left mean they’re being missed.
• The car. New dents and scrapes are worth a closer look.
• Their body. Weight loss, bruises, the same clothes two days running or a change in how they walk.
• The stairs and bathroom. Loose rugs, poor lighting and no grab bars are where most falls start.

Write down what you see before you fly home. Memory blurs fast, and you’ll want specifics for the conversations ahead.

2. Get the Legal Paperwork in Place While Your Parent Can Sign It

This is the step that is most often overlooked by families, and it is the step that causes the most problems when it is not taken. Without the appropriate documents, the hospital will refuse to communicate with you, and the bank will refuse to pay an overdue bill on your parent’s behalf. In case your parent later becomes unable to sign, your choices become limited to the legal process, which is lengthy and costly.

The basic documents that every family needs are:

• Power of attorney for healthcare (healthcare proxy): Who would make decisions for your parents’ healthcare?
• Durable Power of Attorney: This allows somebody else to take care of the payments and other property issues.
• Living Will / Advance Directive: You would be able to decide what kind of treatments your parents want or do not want.
• HIPAA authorization: allows doctors and hospitals to share information with you.

Since rules and forms differ from one state to another, use the services of an elder law attorney from the state where your parent is residing and not from your state. Once all documents have been signed, make sure you have a copy at hand along with your parent and his/her attending physician.

3. Build a Local Team You Can Call

You cannot cross the street to wake up the smoke alarm if its battery beeps in the middle of the night. Someone else can. Think about who those people could be before you need their help and approach them personally.

Good prospects might be your neighbor, your church or senior center friend, a relative living close by, or the building manager. Ask each of them for a particular thing. “Could you knock on Mom’s door if she does not answer my calls for a day?” sounds less demanding than “Could you monitor her health?”

Have all of their contact information and give yours as well. Make sure that at least one of those has a spare key or a lockbox which he or she can access with a particular code in case of emergency. Also, remember to appreciate your helpers.

4. Get Your Siblings on the Same Page

For many families, the sibling that is living nearby is left to do all the work while the others just feel ignored and even guilty about it. The resentment slowly brews on both sides. One quick conversation at the start avoids many problems.

Arrange a monthly call. Assign responsibilities based on what everyone can manage, not who is most available. Just because you are not in the same location does not mean that you cannot be of assistance. A family member from out of town could take care of phone calls related to insurance, paying bills, researching treatment plans, or even covering expenses for the sibling closer to home.

Identify one person to be the primary contact for the physicians and health care professionals. This will eliminate the possibility of having four people making the same call, and it will also prevent your parent from receiving four versions of the information.

5. Keep Everything in One Shared Place

When your dad lands in the ER, nobody should be digging through texts to find his medication list. Put the essentials in one place that you and your siblings can open from your phones, like a shared folder or a notes app.

What belongs there:

• Current medication list with doses, plus allergies
• Doctors’ names, specialties and phone numbers
• Insurance cards (front and back) and Medicare number
• Copies of the legal documents from step 2
• Pharmacy name and phone number
• Local contacts from step 3
• Bank, utility and other account details, kept somewhere secure
• A short health history: diagnoses, surgeries, hospital stays

Update it after every doctor visit or medication change. An outdated list can be worse than no list, especially in a hospital.

6. Stay Involved in Doctor Visits From Afar

Many senior adults leave appointments recalling very little of what the doctor said. If you’re not in the room, you’re trusting on that memory.

Ask your loved ones if you can join appointments by phone or video. Most offices will put you on speaker if your parent agrees and the HIPAA form is on file. Send your questions to the office a day ahead through the patient portal, so they don’t get lost in a rushed 15-minute visit.

However, if you have the consent of your parents, you should try accessing the portal by yourself. This will ensure that you have access to all the information, such as test results, future appointments, and visit notes, without any need for other people to provide you with the information. In case your parents have used any aides during the visits, make sure they text message.

7. Use Technology That Actually Helps

The best tech for an aging parent is the kind they’ll actually use. A gadget that sits in the drawer doesn’t help anyone, so start simple and add only what solves a real problem.

Tools that tend to earn their keep:

• A medical alert device with fall detection, worn as a pendant or watch. It matters most for parents who live alone.
• An automatic pill dispenser that beeps and unlocks only the right dose at the right time.
• A video calling device with big buttons, or a tablet set up so one tap calls you.
• A smart doorbell camera, so you can see who’s coming to the door and spot scammers or unexpected visitors.
• Bill pay and account alerts, so you know right away about unusual charges.

Take care with the cameras at home. Discuss it with your parents beforehand. While everyone usually takes the doorbell camera without much fuss, the living room camera can come across as a violation of their privacy.

8. Know the Signs It’s Time for More Help

Neighbors and weekly phone calls work well for a while. At some point they stop being enough, and the trick is noticing before a fall or a hospital stay forces the decision.

It’s time to think about hands-on help when you notice:

• A fall, or a near miss they mention offhand
• Weight loss or an empty fridge more than once
• Missed medications or doctor visits
• Unpaid bills, scam calls they’ve answered or money that doesn’t add up
• Your parent repeating the same story within one phone call
• The house getting noticeably messier, or your parent wearing the same clothes for days
• A neighbor or friend calling you with a concern
• Your local helper starting to sound worn out

One of these alone might be a bad week. Two or three together, or one that keeps coming back, usually means it’s time for a plan.

9. Understand Your Care Options Before You Need One

The worst time to compare care options is from a hospital hallway with a discharge date tomorrow. Knowing the basics now lets you make a calm decision later.

Many families syndicate these. A common setup is home care a few days a week plus home health visits after a hospital stay. Costs vary a lot by state and by hours, so ask any service provider for a written estimate.

10. Vet a Home Care Agency Carefully When You Can’t Drop By

Bringing in help from other states involves putting your trust in individuals who might never even cross paths with you physically. A good agency anticipates tough questions and gives honest answers.

Questions worth asking:

1. Are caregivers your employees, or independent contractors you refer? (Employees means the agency handles taxes, insurance and supervision. With contractors, much of that can fall on your family.)
2. Are you licensed in this state? Can you send proof?
3. What background checks and training do caregivers complete before their first shift?
4. How do you match a caregiver to my parent?
5. What happens if the regular caregiver calls out sick?
6. How will you keep me updated, and how often?
7. Who do I call at 9 p.m. on a Sunday if something’s wrong?
8. Can I join the first assessment by phone or video?
9. Is there a minimum number of hours per visit or per week?
10. What does it cost, and what’s in writing before we start?

Ask for references from families who also manage care from a distance. Their experience will tell you more than any brochure.

11. Look After Yourself and Let Go of the Guilt

Almost every long-distance caregiver we talk to feels guilty. Guilty for moving away, for not visiting more, for paying someone else to do what they feel they should be doing. That guilt is understandable, but it isn’t a fair measure of how much you care.

You’re still the person who knows your parent’s history, fights with the insurance company and notices when something sounds off on the phone. That’s real caregiving, even from 1,500 miles away.

Set boundaries you can live up to. Schedule visits that you can manage in both ways, emotionally and financially. Seek help from someone, be it your friend, counselor, or caregivers’ support group, many of which are available online nowadays. You will make wiser decisions for your parents when you are not drained.

If Your Parent Lives in Little Rock, Arkansas

Many of the families we work with at A Place at Home – Little Rock, Arkansas live somewhere else. Their parent retired to Little Rock for the weather and the golf, and now the kids are in Denver, Chicago or Los Angeles trying to figure out what to do.